The Global Fund to Fight Aids, Malaria and TB, the largest funder of Aids programmes worldwide, has an estimated shortfall of $3-billion to $5-billion and has begun to scale back dramatically the number of grants it makes.
This emerged at the 5th International Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town this week. Africa is expected to be affected most drastically — Mozambique will receive no money from the fund in the coming year and Tanzania and Swaziland’s domestic Aids programmes are already experiencing major cutbacks.
Aids scientists and activists at the conference raised grave concerns about the potential impact of the global financial crisis on health funding, predicting devastating effects on Aids programmes.
International Aids Society (IAS) president Julio Montaner holds donation governments primarily responsible for under-funding.
“[The IAS is] appalled by the recent G8 meeting,” he said, “where they remained absolutely silent [on Aids funding], and we are one year away from universal access [to treatment] targets in 2010. We will make our G8 leadership accountable … [This silence] is not just pathetic, it’s criminal.”
Professor Jerry Coovadia of the University of KwaZulu-Natal said he was “not surprised” by the shortfall. “As far as I can remember, the struggle for freedom has always been blocked by broken promises from the West.”
But Coovadia also underscored the responsibility of African governments for Aids programmes. “It’s also a problem of our own governments, who are not accountable,” he said.
This week Médécins Sans Frontières announced ARV stock-outs in six African countries — including South Africa, where patients seeking treatment in KwaZulu-Natal are being turned away.
Vuyiseka Dubula of the Treatment Action Campaign said the stock-outs could be blamed entirely on lack of funding. “There is very poor planning and budgeting on antiretroviral roll-out … We don’t have ARV stock-outs just because we don’t have resources — sometimes we do have resources and we’re not using them wisely.”
The financial shortfalls coincide with calls by scientists for increased provision of antiretroviral treatment as a means of preventing further HIV transmission. They say that this could almost eradicate the virus by 2050.
The World Health Organisation’s Reuben Granich presented findings on the “treatment as prevention” model, which calls for universal voluntary testing and placing people on ARVs immediately after a positive result.
Current WHO guidelines recommend that people begin treatment when their CD4 count, a measure of immune response, drops below 350. In South Africa the number is lower, with most public sector patients not receiving drug treatment until their CD4 is well below 200.
Granich’s approach draws on mounting evidence that HIV transmission rates fall dramatically when a person is receiving treatment. Granich said the viral load, or how much HIV is detected in a person’s blood, is “the single greatest risk factor for HIV transmission”.
The ability of ARVs to “lower viral load to undetectable levels” led to lower transmission rates, he said. His model predicted a 95% reduction in new HIV cases in 10 years, with more than seven million lives saved by 2050.
Questions persist about the cost of such a programme, as a heavy initial investment would be required. However, its advocates argue that such an approach could cut costs in the long run, with fewer people developing opportunistic infections, which are expensive to treat, and the global infection rate diminishing greatly.
Montaner said that “in the context of a financial crisis … we need to be very strategic. Investing in ART is a very wise way forward. We know that treatment saves lives and protects families and puts people back to work. There will be no economy if society is crumbling … because they are dying of Aids.”